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Study Shows Innovative Program Helps Kids Get Health Care

IRVINE, CA -- March 21, 2007 -- As state lawmakers consider ways to reach California's 6.5 million uninsured residents, new research from University of California, Irvine suggests that insurance brokers and other for-profit groups are key to helping eligible children enroll in government-funded health care programs.

UCI's Mireille Jacobson evaluated the impact of an innovative California incentive program that encouraged for-profit groups such as insurance brokers and income tax preparers, as well as non-profits, to help enroll children in the State Children's Health Insurance Program or Medicaid – programs for which an estimated 60% of uninsured children are eligible.

The incentive program, which began in 1998, paid $25 to $50 for each person the organization helped enroll or re-enroll in the state health care programs. The number of children successfully enrolled in the SCHIP or Medicaid programs increased under the program, and dropped steeply after 2003, when the state suspended funding for such outreach.

"Clearly, these for-profit organizations effectively help California reach out to families that are eligible for government health care, but who may be confused by the eligibility rules, overwhelmed by the complexity of the forms or have language barriers," said Jacobson, an assistant professor of social ecology.

The study is published in the current issue of the journal Health Affairs. Thomas C. Buchmueller, professor in the Ross School of Business at the University of Michigan, Ann Arbor, coauthored the report.

"At the time the incentive program was suspended in California, it was consuming less than 1% of the Healthy Families budget, so it's a cost-effective tool, as well," Jacobson said.

Jacobson's study also found that when the incentive program was suspended, a greater proportion of incomplete or incorrectly completed enrollment forms were submitted, suggesting that some children who were eligible, might have been denied health insurance.

In 2005, the incentive was reinstituted in California, and the rate of successful health insurance applications again began to rise.

Clinics, schools, community-based organizations and insurance brokers all received incentives to help children enroll in the health care programs, but it was insurance brokers who had the highest acceptance rate. The researchers suggest that as organizations gain more experience submitting applications, they acquire a better understanding of the eligibility rules and documentation requirements, and then have higher success rates enrolling children.

Three other states – Illinois, North Carolina and Virginia – provide similar incentives to insurance brokers who help enroll people in state health care. Jacobson says the research suggests other states may want to consider such programs, as well.

"These insurance programs exist to help protect and ensure the health of the youngest and poorest Californians, and it turns out these programs can more effectively do that with a little help from the for-profit sector," Jacobson said.

This research was funded by the Robert Wood Johnson Foundation Scholars in Health Policy Research Program and the University of Michigan's National Poverty Center.


SOURCE: University of California, Irvine

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